Manic-depressive psychosis (manic depression) nowadays is one of the most studied affective disorders (mood disorders). It takes the form of manic phases and depressive phases, between which there is a so-called intermission period (at this time, the symptoms of manic-depressive psychosis disappear, and there is a complete integrity of the characteristics of the patient’s personality).
In this paper I would like to consider in detail how a manic-depressive disorder is formed, which forms it may have and how the phases of the disease are alternated (Saritha Pujari).
Preconditions of the Formation of the Disease
Manic-depressive psychosis has two peaks of occurrence. The first happens at the age from 20 to 30 years, and the second - at the climacteric period (or the period of involution). The disease is seasonal, its exacerbations usually occur in spring and autumn. In addition, manic depression is manifested by the daily fluctuations of the mood: as a rule, the patient's condition is much worse in the morning than in the evening.
Manic-depressive psychosis has a strong hereditary reason: often one of the children or the parents of the patient suffer from the same illness (or they may have any other affective disorder).
Also among the factors of the development of this disease can be such causes (or preconditions) - constitutional features of a person, the body's endocrine processes (for example, for women - childbirth, menstruation, menopause). In addition, the disruption of certain brain structures (for example, because of tumors or chemical exposure) may also act as a cause, as a result of which manic and depressive syndromes develop.
Thus, it is evident that the preconditions of the disease are obviously biological, and those mood disorders and psychological imbalance which we can observe from the side are only the consequences of much more deep-seated biological processes (Saritha Pujari).
Phases of the Disease and their Characteristics
As I have already mentioned, manic depression manifests itself through the separate phases of the disease - manic, depressive, and the gap between them - intermission, during which the person looks completely healthy, and his personality, intellect and mind remain intact.
The depressive phase is characterized by the following symptoms: chronically decreased, melancholy mood, physical and mental retardation. Patient’s movements and speech are slowed down, the mood is depressive. Such an emotional state the patient relates to the past, to the present and to the future: “Everything was bad in my life, and now it is bad, too, and it will get only worse”. Despite the symptoms are similar to some neurotic disorders, manic-depressive psychosis in the depressive phase should be distinguished from various forms of neurosis. Daily fluctuations of a person's mood, or more precisely, so to say, their features help us to do that. During manic-depressive psychosis the depressed mood typically gets better in the evening, and during nervousness, on the contrary, the mood is better in the morning.
This is related to the fact that the disease has primarily biological nature. Patients notice a dry mouth, and an intestinal atony, as a result of which there are chronic constipations, develops. Furthermore, these patients are characterized by a special form of insomnia: in the evening they fall asleep easily, but they wake up too early (at 3-5 a.m.)
Of course, such a detailed syndrome is found not often. For example, anergic depression (melancholy syndrome which is less expressed and is characterized by a lack of energy and light inhibition) is much more common. While being in this state, the patient often notes that he would like to do something, but “the hands do not rise”. Relatives should understand that they cannot shame the patient in this situation or put pressure on him in order to finally make him do something. This will only lead to an escalation of the feeling of guilt and the depression will deteriorate. In addition, in the depressive phase anxiety can be observed – then we may talk about an anxiety and depressive syndrome.
The manic phase of the disease is the complete opposite to the depressive - it is characterized by the mental excitement, painfully elevated mood and general physical arousal. A patient is constantly in motion; he grabs the next work without completing the previous one. He is constantly distracted; his thoughts also “jump” from one topic to another.
Typically, a person's mood in this phase is “abnormally positive”, he tells some anecdotes, jokes and he cannot calm down. But sometimes there is an anger mania, it is more common for the patients who have experienced a traumatic brain injury or have some cardiovascular disorders. Symptoms of these patients are similar to the classical picture, but a high irritability is added - the patient loses his temper because of the slightest reason (Saritha Pujari).
Phase Rotation: Forms of the Disease
Manic-depressive psychosis is actually characterized by a change of manic and depressive phases, but it does not mean that one of them necessarily replaces the other. In most cases, for four depressive phases there is only one manic. In connection with this, the disease can be subdivided into two forms:
Unipolar disorder. During it, the clinical picture is characterized by only one phase which is shown more often (usually depressive), between its repetition there is a “bright period”, i.e. intermission, when the patient feels well. Thus, having unipolar disorder, the alternation of the periods is as follows: depression - intermission - depression - intermission, etc. The manic phase in this alternation occurs very rarely.
Bipolar disorder. In this case, both depressive and manic phases are manifested. Their alternation is approximately the next: depression - intermission - manic period - depression, etc. Thus, it becomes clear that the term “bipolar disorder” essentially describes only one of the forms of manic-depressive psychosis. It is a complex disease with the alternating periods of different affective states, but bipolar disorder is only a special case.
Sometimes there is a double phase - depressive period immediately turns into a manic. The period of depression is long and lasts from 3-4 months to 1 year. Manic phase is much shorter and lasts no more than 4 months. Sometimes, during the disease mixed phases may occur, when the symptoms of depression and manic symptoms are simultaneously present. Most often, it happens during the transition of the patient from one phase to another (Saritha Pujari).
Treatment Methods
The treatment of manic-depressive psychosis is directly dependent on the current period of the illness, severity of the symptoms, clinical features of the disease (e.g., anxious depression or depression with delusions) and a number of other factors.
Having manic-depressive psychosis in a depressive phase, the doctor prescribes antidepressants of different groups, depending on the clinical picture of the disease. In any case, as during the normal depression, in this case also occurs a violated reuptake of serotonin, noradrenaline, etc. Therefore, the scheme of treatment is similar to the usual treatment of depression.
If we consider manic-depressive psychosis in the manic phase, neuroleptics with sedative effect or anti-manic effect are commonly used. Also in the manic phase lithium therapy is effective.
In a depressive or manic period, when mental disorders are brightly expressed, the patient is unable to work. In periods of intermission, the ability to be engaged in labor activity is restored. However, during too frequent or prolonged phase states, manic-depressive psychosis equates to a chronic disease of the psyche.
The relatives of the patient must constantly monitor his condition in order to recognize the first symptoms of depression and to prevent the possible suicide attempt. Not all people with this diagnosis are completely inadequate. They just need a timely and proper treatment which will help them to live quite a normal life, to create a family and be engaged in favorite business. At the same time it is very important to protect them from the various stresses and difficult situations, because at such an unfavorable background exacerbation of the disease may occur (Saritha Pujari).
References
Saritha Pujari. (N.d). Manic Depressive Psychoses: Types and Explanation of Manic Depressive Psychoses. Retrieved from http://www.yourarticlelibrary.com/depression/manic-depressive-psychoses-types-and-explanation-of-manic-depressive-psychoses/12496/
